Loading...
B-2016-1621CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT P 10: B-2016-1621 23500 CRISTO REY DR UNIT 420G CUPERTINO, CA 95014-6533 (342 53 201) BAYAREA ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: NYGREN ELIZABETH TRUSTEE DATE ISS D: 05/05/2016 OWNER'S PHONE: PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class j3 Lic. #817817 ontractor. BAY AREA ENTERPRISE Date 03/31/2017 X BLDG X ELECT —PLUMB MECH X RESIDENTIAL OMMERCIAL I erehy affirm that I am licensed under the provisions of Chapter 9 (commencing _ wi h Section 7000) of Division 3 of the Business &Professions Code and that my lie se is in full force and effect. JOB DESCRIPTION: WIDEN OPENING FROM LN G ROOM TO DEN FROM 48" TO 75" I reby affirm under penalty of perjury one of the following two declarations: (NON -LOAD BEARING WALL); INSTALL 3 (N) ELECTRICAL 1. I have and will maintain a certificate of consent to self-insure for Worker's OUTLET; MOVE (E) LIGHT AT INING TO LIVING ROOM Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2, have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $3900.00 " permit is issued, APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupanc Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 342 53 201 representatives of this citq`to enter upon the above mentioned property for inspection purposes. ( e) agree to save indemnify and keep harmless the City of Cupertino again ttii bilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORD IS NOT STARTED may accrue against said Ci inconsequence of the granting of this permit. Additionally, the ap fc int u derstands and will comply with all non-point WITHIN 180 DAYS O PERMIT ISSUANCE OR source regulatio` r e *upertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 05/05/2016 Issued by: PAUL O'SULLIVAN (s� Date: 05/05/2016 OWNER-BUILDER DECLARATION I hereby affirm that.1 am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to a y roofing material being installed. If a roof is following two reasons: t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an ins ection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for i ispection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code), Date: 05/05/2016 1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERING TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS I have the hazardous materh DISCLOSURE Is requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by read California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance _of the work for which this maintain compliance with the Cape rtino Municipal Code, Chapter 9.12 and the permit is issued. s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 2 material. Additionally, should I use 532(-) should store or handle hazardous equipm nt or devices which emit hazardous shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the ay e' Air uality Managemen�t District I 1VIu icfpal Code,�h�apter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the the Health &Safety Code ape Sec 'o s 255 5, 25533 �Sd 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: IGENCY APPLICANT CERTIFICATION Date: 05/05/2016 I certify that I have read this application and state that the above information is laws NS TI I hereby affirm that there is a consiructi 3N LENBUG g agency for the performance correct. I agree to comply with all city and county ordinances and state of work's for which this permit is is ued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be us d as public records. Code, Section 9.18. Licensed Signature Date 05/05/2016 Professional CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • bulldinn@cuperiino.org ❑ ADDITION SLTERATION 1 TI ❑ REVISION /DEFERRED PERMIT PROECTADDRIESS �! )�APNl2 j qz- •� s �� Z OWNEitNAT,tE 9LIZA&C-7 (00- _ rsrz MAIL -rl%4L f:6v-uvk se•cdct STREETADDRESS 14-L4CTTY, STATE, ZIP FAX CONTACT NAME Gre ' S PHONE -2.3 a —S 00.3 GM %re �e��•�c�t� STREET ADDRESS CITY, STATE, Zip z l J ti r C' V'r4 loftV97 5-1 PAX ❑ OWNER 13 OWNER -BUILDER 13 OWNERACENT b4 CONTRACTOR ❑ CONTRACTORACENT I:1 ARCHITECT ❑ EN0149ER ❑ DEVELOPER CI TENANT CONTRACTORNAME &L&► F' LIC13 ENNUMDER eiriffe7 LICENSETYPE BUS.LICrr COMPANYNA4 EIv1AILcA ' re Jr t) I•AX I. -L CITY, STATE, STREET ADDRESS7.n' ARCHITECTIENGINEERNAME . LICENSENUI:MER EUS. 111C COMPAWY NAME E-MAIL FAX STREGr ADDRESS CITY, STATE, ZIP PHONE i+ DESCRIPTION OF WO f + ESH Ie EXISTING USE WW PROP ED List CONSTR. TYPE HSTORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET ARBA nATHROOM REMODELAREA KITCHEN REMODEL AREA. OTHER REMODEL AREA PORCH AREA 13ECKAREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH 1❑ ATTACH ADWELLING .UNITS:ISASrsCONDUNIT ❑YES SECONDSTORV [IVES BEING ADDED? []NO ADDITION? FIND PRE-APPWCATION ❑YES IF Yas, PROVIDE COPY OF IS THE BLDG AN DYES "RGGEIVED.EX:= TOTAL VALUA'I10=_ PLANNINGAPPLO []NO PLANNING APPROVAL LIRTER EICHLERHONIE? ©NO By my signature below, I certify to each of the foam the ' Ig: I athe property owner or authorized agent to act on the pr periy awn 's behalf. I ave read this application and the information I have provided is co et. I lla ad the Description of Work and verify it is accurate, i agree t comply ith ail applicable local ordinances and state laws relating to building on ction. I a Drize representatives of Cupertino to enter the above-ydentified.p o�itlspectionurposes. ' "= ✓ 0/ Signature of Appl icantlAgent: Rafe: SUPPLEMENT INFORMATIOINREQUIRED JPLAN:CHIECKTM, 13 OVER -THF COUNTER © BUI[l}INGPLAN Ii&VIE�Y" New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building, ❑. ".L'jiPRESS. ... _ © P1",ANN.1NG-PLANR9VTF W . Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0. STANDARD 0-PUMAMWORIts -for—in if arty I3azardous Materials are being used as part of this plvject. --0 LARGE ❑ rl r> Darr — Copy ofPlanning Approval Utter or Meeting with Planning prior to 0 MAJOR 0 SANITA'ky.SEWERd71S'C1iICr submittal of Building Permit appli cation. • � EN.VIRONh1ENTAt NEA:LTH • Bl lg4ppjOl Ldoe revised 06121111 A